Strut attachments for external fixation frame

ABSTRACT

Disclosed herein are strut attachments for external fixation frames. The strut attachments provide solutions for frame configurations in which it is not possible to attach a strut at its ends to corresponding rings. The strut attachments may be considered an outrigger type of mechanism that achieves more travel out of completely collapsed struts. The strut attachments, each having a pivot and a hinge joint, allow a strut to be attached on the level of a first ring and extend at least partially proximally or distally to a second ring depending on the frame of reference of the ring system. These strut attachments may be used when the fully collapsed length of the strut will not allow the rings to get any closer to one another than is needed or proscribed. In such cases, the strut attachments allow for even tighter ring to ring distance.

FIELD OF THE INVENTION

The present disclosure relates to systems and components of external fixation frames. More particularly, the present disclosure relates to strut attachments for varying the attachment point of a strut to rings of such frames.

BACKGROUND OF THE INVENTION

Many different types of bone deformities can be corrected using external fixation systems to perform the distraction osteogenesis process. For example, an Ilizarov device or similar external fixation system may be used. Such systems generally use rings also designated as fixation plates connected by threaded rods or struts for manipulation, lengthening, angulation, rotation, and translation of deformities of bones. The position of a threaded rod within a hole of a ring is generally fixed using nuts and washers. Adjustable length or telescopic struts are generally fixed to rings at opposite ends thereof with the length of the struts being adjusted by changing the position of a threaded rod within a cylindrical shaft.

As the struts are manipulated, the rings or fixation plates change positions relative to one another, causing the bones or bone segments attached to the fixation plates to change positions relative to one another, until the bone segments are in a desired position relative to one another. Fixation systems have many areas which may be improved including, for example, the ease and precision with which the fixation system may be adjusted by a user, whether a clinician or a patient.

Telescopic struts are used to reduce/treat fractures and correct deformities over time. Patients correct the deformities by prescribed adjustments of the struts. The lengths of the struts are adjusted over time to change the position and orientation of the two rings with respect to one another, which in turn repositions and reorients the bone fragments, with a goal of correcting the bone deformity. The adjustment of the external fixator generally complies with a predetermined correction plan. The struts are generally assembled in a hexapod platform configuration consisting of six struts and gradually adjusted in length (by hand or via an instrument) to address the indicated deformities. The disengagement of such a strut's quick release mechanism, for example, can free the frame and allow the surgeon to quickly manipulate ring position, simplifying frame assembly and fixation to the deformity. Depending on the type of deformity, a strut may run out of its minimum length when the telescopic lengths of components are completely collapsed. In such cases, it would preferable to have a strut connected to a respective ring about its length rather than at its end.

BRIEF SUMMARY OF THE INVENTION

The present invention provides solutions for frame configurations in which it is not possible to attach each strut at its ends to corresponding rings. The strut attachments of the present invention may be considered an outrigger type of mechanism that achieves more travel out of completely collapsed struts. The present invention uses a special type of strut, that attaches on the level of a first ring and extends at least partially proximally or distally to a second ring depending on the frame of reference of the ring system. The strut attachments may be used when the fully collapsed length of the strut will not allow the rings to get any closer to one another than is needed or proscribed. In such cases, the strut attachments allow for even tighter ring to ring distance.

In another embodiment, instead of having a first end of a first strut located proximally to a top surface of a first ring, the first end of the first strut is located between top and bottom surfaces of the first ring. By having a strut attachment member in the shape of a C-clamp, a pivot point of the strut can consistently be at a center the ring thickness between the top and bottom surfaces thereof.

A first aspect of the present invention is with regard to the strut attachment member coupled to each strut in an external fixation system. Each strut attachment allows for two degrees of freedom between the strut and a respective ring that the strut is coupled to. The two degrees of freedom is obtained by utilizing one pivot joint and one hinge joint. The struts of the present invention include a threaded rod that rotates with respect to a telescopic tube. A function of the threaded rod being able to rotate with respect to the tube provides an additional degree of freedom. It also allows the struts to be attached and tightened directly to the rings. Overall, each strut will have two degrees of freedom at each end and one degree of freedom at the threaded rod level for a total of five degrees of freedom.

A second aspect of the present invention is with regard to coupling a strut attachment member to a body of a strut. The struts have a variable attachment point that will allow it to have at least two different attachment sites on the body of the strut. The attachment sites can either be at the middle of the strut body or at an end of the strut body. Coupling the strut attachment to the middle of the strut body provides a tight ring to ring distance when needed.

A third aspect of the present invention is a telescopic tube having markings on opposite sides of a slot about a length of the tube. These markings allow the tubes to display accurate lengths of the struts when the strut attachment is coupled to the strut body at its middle or at its end.

Another aspect of the present invention is an external fixation system comprising first and second ring members and first and second strut attachments members. The first strut attachment member is pivotably coupled at a first end to the first ring member and at a second end to a first end of an adjustable length strut. The second strut attachment member is pivotably coupled at a first end to the second ring member and at a second end to a length of the adjustable length strut.

In one embodiment of this aspect of the present invention, the first strut attachment member includes first and second pivot portions, the first pivot portion pivotably coupling the first strut attachment member to the first end of the adjustable length strut about a first axis and the second pivot portion pivotably coupling the first strut attachment member to the first end of the adjustable length strut about a second axis perpendicular to the first axis.

In another embodiment, the first end of the first strut attachment member has a bore adapted to receive a fastener for securing the first end of the first strut attachment member to at least one of a plurality of holes in the first ring.

In yet another embodiment, the first end of the first strut attachment member is located proximally to a top surface of the first ring when the first strut attachment member is coupled to the first ring.

In still yet another embodiment, the adjustable length strut comprises a rod member, a tube member and an actuation mechanism. The rod member extends between the first end and a second end of the adjustable length strut, the rod member including external threads. The tube member extends between the first and second ends of the adjustable length strut, the tube member including a hollow portion adapted to receive the rod member and an engagement feature adapted to engage the external threads of the rod member. The actuation mechanism rotatably fixed to the rod member, the actuation mechanism including a plurality of gear teeth extending radially outward of a longitudinal axis of the rod member.

In still yet another embodiment, the adjustable length strut further comprises a protrusion member coupled to an end portion of the rod member, the protrusion member extending substantially orthogonal to the longitudinal axis of the rod member, the protrusion member includes a collar portion substantially surrounding the end portion of the rod member, wherein the collar portion is freely rotatable with respect to the end portion of the rod member.

In still yet another embodiment, the tube member includes an elongate slot extending through inner and outer surfaces of the tube member, a portion of the protrusion member extends through a portion of the elongate slot, and wherein the tube member includes visual indicia on the outer surface thereof adjacent the slot.

Another aspect of the present invention is an external fixation system comprising a first ring member, a second ring member, a first strut attachment member pivotably coupled at a first end to the first ring member and at a second end proximate to a first end of an adjustable length strut, and a second strut attachment member pivotably coupled at a first end to the second ring member and at a second end to an outer surface of the adjustable length strut between the first end a second end of the adjustable length strut.

Another aspect of the present invention is an external fixation system comprising a first ring member, a second ring member, a first strut attachment member pivotably coupled at a first end to the first ring member and at a second end to a first end of an adjustable length strut, and a second strut attachment member pivotably coupled at a first end to the second ring member and at a second end to one of a plurality of positions about the length of the adjustable length strut between the first end and a second end of the adjustable length strut.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the subject matter of the present invention and the various advantages thereof can be realized by reference to the following detailed description in which reference is made to the accompanying drawings in which:

FIG. 1 is a perspective view of an external fixation system according to an embodiment of the disclosure.

FIG. 2A is a perspective view of a strut of the external fixation system of FIG. 1.

FIGS. 2B-C are perspective views of the strut of FIG. 2A with certain components omitted.

FIG. 2D is a perspective view of an actuation mechanism of the strut of FIG. 2A.

FIG. 3 is a perspective view of the external fixation system of FIG. 1 with modular attachment members coupled to the struts.

FIG. 4 is a perspective view of an external fixation system according to an embodiment of the disclosure showing strut attachment members of the present invention coupling first and second struts to respective first and second rings.

FIG. 5A is a perspective view of a strut with strut attachment members coupled to the strut in a first configuration.

FIG. 5B is a perspective view of a strut with strut attachment members coupled to the strut in a second configuration.

FIG. 6A is a perspective view of a strut attachment member of the present invention that is configured to be coupled about the body of a strut.

FIG. 6B is a partially exploded perspective view of a ring connector portion separated from the intermediate and coupling portions of the strut attachment member shown in FIG. 6A.

FIG. 6C is a perspective view of the ring connector portion shown in FIG. 6A.

FIG. 7 is a perspective view of a strut attachment member of the present invention that is configured to be coupled at an end of a strut.

DETAILED DESCRIPTION

FIG. 1 shows an external fixation frame 10 in an assembled condition according to one aspect of the disclosure. Generally, fixation frame 10 includes a first ring 20 and a second ring 30, with six telescopic struts 100 a-f coupling the first ring 20 to the second ring 30. The first ring 20 may also be referred to as a proximal ring or a reference ring, while the second ring 30 may also be referred to as a distal ring or a moving ring. In the illustrated embodiment, each strut 100 a-f includes a threaded portion that may thread into or out of a tube portion, for example by interaction with quick release mechanism 130, to decrease or increase the length, respectively, of the telescopic strut. Each end of each strut 100 a-f may be coupled to the first ring 20 and second ring 30 via a joint mechanism, such as a ball joint, a constrained hinge joint, or a universal joint as illustrated. The use of universal joints on each end of the strut provides for six degrees of freedom of motion of the external fixation system 10. It should be understood that although the disclosure is generally described in the context of closed circular rings, the concepts described herein may apply with equal force to other types of rings, such as open rings and/or U-shaped rings.

In external fixation system 10, telescopic struts 100 a-f are used to reduce fractures and correct deformities over time. Patients correct the deformities by prescribed adjustments of the struts 100 a-f. The lengths of the struts 100 a-f are adjusted over time to change the position and orientation of the two rings 20, 30 with respect to one another, which in turn repositions and reorients the bone fragments, with a goal of correcting the bone deformity. The adjustment of the external fixator 10 should strictly comply with the predetermined correction plan.

Rings 20 and 30 of external fixation system 10 may include a plurality of extension tabs 50. In the illustrated example, each ring 20 and 30 includes six extension tabs 50 spaced circumferentially around the perimeter of the respective rings, although more or fewer may be suitable depending on the particular components of the fixation system. In addition to what is described directly below, extension tabs 50 may help increase the cross-sectional area of rings 20, 30 and thus provide for increased stiffness of the rings.

With this configuration, each ring 20, 30 includes a first inner circumferential row of holes 60 and a second outer circumferential row of holes 70. As illustrated, the second outer circumferential row of holes 70 may be only positioned on the plurality of extension tabs 50 on the rings 20 and 30. It should be understood that although the second outer circumferential row of holes 70 is shown in FIG. 1 as being positioned solely on extension tabs 50, top ring 20 and/or bottom ring 30 may contain two complete rows of holes, for example with a completely circular (or nearly completely circular) geometry. The use of extension tabs 50, compared to two full circumferential rows of holes, may help reduce overall bulk of rings 20, 30 and also provide for intuitive strut placement for surgical personnel. The completely circular version of rings 20, 30 with two full (or nearly full) rows of circumferential holes may be particularly suited for relatively small diameter rings, although indentations or other features may be introduced to provide an intuitive interface for strut placement by surgical personnel. Further, in the illustrated embodiment, the first and second circumferential rows of holes 60 and 70 are positioned so that the first row of holes 60 does not align radially with the second row of holes 70. In other words, the first row of holes 60 has a staggered configuration with respect to the second row of holes 70. The additional hole options may also be utilized for connecting other components, such as fixation pins to couple the rings 20, 30 to the respective bone fragments. Still further, the staggered configuration of holes between the first and second rows 60, 70 may also help prevent interference between components attached to nearby holes, for example such as a strut 100 a-f positioned in a first hole and a fixation pin or other fixation member attached to an adjacent or nearby second hole. For example, a relatively thin wire extending radially from one of the holes in the first circumferential row 60 may not radially interfere with a hole positioned in the second circumferential row 70 because of the radial staggering. It should be understood that the size of the tabs 50 may increase or decrease depending on the diameter of the rings 20 and 30, with greater diameter rings 20 and 30 having larger tabs 50 with more holes 70 compared to smaller diameter rings. For example, the illustrated tabs 50 include six holes 70, and a smaller ring may include smaller tabs with four holes each, for example.

FIG. 2A illustrates a perspective view of one telescopic strut 100 from the external fixation system 10 of FIG. 1. It should be understood that the components of struts 100 a-f may be identical to one another, although some struts 100 a-f may have different sizes than other struts 100 a-f and may include different indicia, such as colors or markings for identification purposes, as described in greater detail below. For purposes of this disclosure, the term proximal refers to the top of the strut 100 in the orientation of FIG. 2A, and the term distal refers to the bottom of the strut 100 in the orientation of FIG. 2A. The proximal end portion of strut 100 may include a first joint 110, which is shown in this example as a universal joint. Joint 110 may include a proximal portion 111, which may include a first aperture 112 aligned substantially parallel with the longitudinal axis of strut 100 and a second aperture 113 aligned substantially transverse or orthogonal to the first aperture 112. The first aperture 112 may be configured to receive a fastener that passes through a hole in proximal ring 20 to secure the proximal portion 111 of joint 110 to proximal ring 20. The fastener may be connected so that the proximal portion 111 does not rotate relative to proximal ring 20. The second aperture 113 may be configured to receive a portion of a tool to prevent proximal portion 111 from rotating, for example while a fastener is being screwed into or otherwise inserted into first aperture 112. Joint 110 may also include a distal portion 115 with a first aperture 116 and a second aperture 117, the first and second apertures 116, 117 being aligned substantially transverse and/or orthogonal to one another and to the longitudinal axis of strut 100. First and second apertures 116, 117 may be used as attachment points for attaching additional components to strut 100 such as modular attachment piece 180 shown in FIG. 3 and further described in U.S. Ser. No. 15/181,614 titled “Gear Mechanisms for Fixation Frame Struts,” the disclosure of which is incorporated by reference herein in its entirety.

Still referring to FIG. 2A, strut 100 may include additional components including an actuation mechanism 120, a quick-release mechanism 130, a strut identifier 140, a threaded rod 150 (not visible in FIG. 2A), a tube 160, and a second joint 170. As noted above, the effective length of strut 100, which may be thought of as the distance between the proximal end and distal end of strut 100, may be adjusted by threading the threaded rod 150 of strut 100 into or out of tube 160 through interaction with quick-release mechanism 130.

FIG. 2B illustrates strut 100 with tube 160 omitted for clarify of illustration. FIG. 2C illustrates strut 100 with tube 160, as well as quick-release mechanism 130, strut identified 140, and second joint 170 omitted for clarity of illustration.

Actuation mechanism 120 is shown isolated in FIG. 2D. Actuation mechanism 120 may be generally a short, cylindrical component with a plurality of ridges or gear teeth 122 extending around the circumference of actuation mechanism 120. The actuation mechanism 120 may be rotatably coupled to threaded rod 150 so that rotation of actuation mechanism 120 causes a corresponding rotation of threaded rod 150. For example, actuation mechanism 120 may have a channel 124 extending therethrough, with an extension 126 in channel 124 that mates with a corresponding extension in threaded rod 150, so that rotation of actuation mechanism 120 causes rotation of threaded rod 150. It should be understood that the threaded rod 150 may rotate with respect to the first joint 110, the first joint 110 and second joint 170 being rotatably fixed to rings 20 and 30, respectively. The proximal surface of actuation mechanism may include a plurality of divots of grooves 128 sized to accept a ball which is biased into the groove via a spring. The spring may have a first end in contact with a distal surface of first joint 110, with a distal end pressing a ball into the proximal surface of actuation mechanism 120. With this configuration, an amount of force is required to rotate actuation mechanism 120 to overcome the force of the spring pushing the ball into the divot 128. As rotation of actuation mechanism 120 continues, the ball will eventually be positioned adjacent an adjacent groove 128. As rotation continues further, the spring will force the ball into the next groove 128 when the ball is aligned with the groove 128, causing a tactile and/or audible click. Each “click” may correspond to a particular axial change in length so that a user knows, for example, that four “clicks” correspond to 1 mm of length adjustment. Similar “clicking mechanisms” are described in greater detail in U.S. Pat. No. 8,834,467, the contents of which are hereby incorporated by reference herein.

Referring now to FIGS. 2A-B, quick-release mechanism 130 may generally take the form of an outer housing that surrounds a portion of threaded rod 150. Quick-release mechanism 130 may have a disengaged state and an engaged state. In the disengaged state, threaded rod 150 may be capable of moving into or out of tube 160 without rotation of the threaded rod 150, for quick adjustments of the length of strut 100, which may be useful for example while initially assembling the fixation frame 10. Rotating the quick-release mechanism 130 may transition the quick-release mechanism 130 into the engaged state, in which threated rod 150 may only move axially into or out of tube 160 via rotation of the threaded rod 150. The mechanism for keeping the quick-release mechanism 130 in the engaged state may include a ball or other feature that is forced between adjacent threads of threaded rod 150 so that axial translation of the threaded rod 150 is only possible via rotation, so that rotation of threaded rod 150 axially moves the threaded rod 150 into the tube 160, without requiring the tube 160 to have internal threading. It should be understood that the quick-release mechanism 130 is not a necessary component of strut 100, and may be omitted from strut 100 if desired. If quick-release mechanism 130 is omitted, it may be preferably to include internal threads on tube 160 to correspond to external threads on threaded rod 150. Further details of quick-release mechanisms have been described elsewhere, including, for example, in U.S. Pat. No. 9,101,398, the contents of which are hereby incorporated by reference herein.

A strut identifier 140 may be coupled to strut 100 at any desired location, for example between the quick-release mechanism 130 and the tube 160. Strut identifier 140 may take the form of a clip or any other suitable shape that can be quickly and securely clipped onto the strut 100 and removed from strut 100. For example, in the illustrated embodiment, strut identifier 140 is a “C”-shaped clip that is flexible enough to open for easy connection to strut 100, but rigid enough that the strut identifier 140 is not easily removed from strut 100 without intentional application of force. Strut identifier 140 may have a color or other identifier such as a number, letter, or shape pattern. Each strut 100 a-f may have a strut identifier 140 that is structurally similar or identical, but that each has easily distinguishable indicia, such as different colors, different numbers, etc. Strut identifiers 140 may be used so that each strut 100 a-f is easily distinguished from one another, and so that other matching indicia may be provided on other components, described in greater detail below, that may be added onto struts 100 a-f so that each additional component may be easily matched with the correct corresponding strut 100 a-f. Strut identifier 140 may also function to prevent unintentional disengagement of the quick release mechanism 130.

Referring again to FIG. 2A, tube 160 may be a generally hollow cylindrical tube configured to allow threaded rod 150 to move axially into or out of tube 160 to decrease or increase the effective length of strut 100, respectively. As noted above, such axial movement may be produced by rotation of threaded rod 150 when the quick release mechanism 130 is in the engaged position, so that the threads of the threaded rod 150 engage the ball or other mechanism within the quick release mechanism 130. If omitting the quick release mechanism 130, the tube 160 may include internal threads that mate directly with the external threads of the threaded rod 150. A slot 162 may extend along part of the length of the tube 160, the slot 162 opening the hollow inside of the tube 160 to the exterior of the tube at both inner and outer sides such that there are two slots 162 at least one of which will be visible to the user depending on the orientation of tube 160 during use. The slot 162 may have a width slightly larger than the width of button 152. Referring now to FIGS. 2B-C, the distal end of threaded rod 150 may include a button 152 coupled to a collar 154, the collar 154 surrounding the distal end of threaded rod 150. Collar 154 may be positioned with a groove at the distal end of threaded rod 150 so that collar 154 may rotate freely around the axis of the strut 100 while being axially fixed with respect to the threaded of 150. Referring again to FIG. 2A, as threaded rod 150 is threaded into or out of tube 160, button 152 travels up or down the slot 162 of the tube 160, which is possible because button 152 and collar 154 are free to rotate with respect to threaded rod 150. Tube 160 may include indicia, such as hash marks and/or measurements, on or adjacent to slot 162. The position of button 152 along slot 162 may correspond to the effective length of the strut 100, so that a user can easily determine the effective length of the strut based on the indicia adjacent to the position of button 152 at any particular time.

Referring still to FIG. 2A, the distal end of tube 160 may include two extensions that form a proximal portion 171 of second joint 170. Second joint 170 may include a distal portion 175 that, together with proximal portion 171 and an internal mechanism form a universal joint similar to first joint 110. Distal portion 175 may include a first aperture 176 that is aligned substantially parallel with strut 100. Aperture 176 may be adapted to receive a fastener therein to couple second joint 170 to distal ring 30. The fastener may be a screw or other type of fastener, and may be adapted to tightly couple the second joint 170 to the distal ring 30 so that the second joint 170 does not rotate with respect to distal ring 30. With this configuration, the slot 162 of tube 160 may be positioned outward (away from the center of proximal and distal rings 20, 30) so that the position of button 152 with respect to indicia on tube 160 may be easily read at all times. The distal portion 175 of second joint 170 may include a second aperture 177 aligned substantially orthogonal to first aperture 176 and adapted to receive a tool to keep second joint 170 from rotating, for example while a fastener is screwed into first aperture 176. This may help ensure, for example, the slot 162 of tube 160 is facing away from the center of the rings 20, 30 as the strut 100 is tightened to the rings 20, 30. It should also be understood that in some prior art devices, rotational freedom of the strut was provided by loosely coupling the joint(s) to the ring(s) so that the joints themselves could swivel. In the present disclosure, the rotational degree of freedom is provided by the ability of threaded rod 150 to rotate, while the tight attachment of the first joint 110 and second joint 170 to the first ring 20 and second ring 30 provides for a more stable connection.

It should be understood that strut 100 as described above may be designed for manual actuation, for example by a user gripping the actuation mechanism 120 with his hand and manually rotating the actuation mechanism 120. However, it should be understood that a tool may be used, either directly on actuation mechanism 120 or with intervening components, to adjust the length of strut 100. For example, FIG. 3 illustrates the external fixation system 10 of FIG. 1 with completely identical components, with the exception that each strut 100 a-f includes a modular attachment piece 180 coupled to a corresponding strut 100 a-f. As is described in U.S. Ser. No. 15/181,614 incorporated by reference herein, modular attachment piece 180 provides a variety of benefits, including a simple way to allow a user to adjust struts 100 a-f with a tool rather than through manual adjustment.

FIG. 4 is a perspective view of an external fixation system 10′ according to another embodiment of the disclosure showing strut attachment members 310, 370 of the present invention each coupling first and second struts 200 a, 200 b to respective first and second rings 20, 30. FIG. 5A is a perspective view of first strut 200 a with strut attachment members 310, 370 coupled to the strut in a first configuration while FIG. 5B is a perspective view of second strut 200 b with strut attachment members 310, 370 coupled to the strut in a second configuration. In reference to first and second struts 200 a, 200 b, each may include additional components including an actuation mechanism 220, a quick-release mechanism 230, a strut identifier 240, a threaded rod 250 (not visible in FIGS. 5A, 5B), a tube 260 and a slot 262 extending along the length of the tube 260. As noted above, the effective length of struts 200 a, 200 b, which may be thought of as the distance between the proximal end and distal end of strut 200 a, 200 b, may be adjusted by threading the threaded rod 250 of each strut 200 a, 200 b into or out of tube 260 through interaction with quick-release mechanism 230.

In reference to FIGS. 5A and 5B, the proximal end portion of each strut 200 a, 200 b include a first strut attachment member 310 instead of first joint 110 shown, for example, in FIG. 2a . Each strut 200 a, 200 b also include a translatable second strut attachment member 370 instead of fixed location second joint 170 as also shown, for example, in FIG. 2 a.

Strut attachment member 310 is pivotably coupled at a first end thereof to a first ring member 20, 30 and at a second end thereof to a first end of adjustable length strut 200 a, 200 b. Strut attachment member 370 is pivotably coupled at a first end thereof to a second ring member 20, 30 and at a second end thereof to a length of the adjustable length strut 200 a, 200 b. The struts of the present invention has at least two modes of operation, such as “Long mode” in reference to strut 200 a and “Short Mode” in reference to strut 200 b.

When the surgical indication require a very tight righ to ring distance, strut attachment member 310 is fixed to a proximal ring, for example, while strut attachment member 370 is attached to a middle portion of the strut, followed by attaching that level to the distal ring, for example. At this point, the struts will be either in the minimum distance between the joints or somewhere between the minimum and the maximum distance of the joints. During correction when the strut is extended to the maximum length, which is represented by the indicator pins touching the top of the slot of the tube, the strut change out device is applied. The strut change out device holds the two rings tight with respect to each other. At this point bottom joint that is attached to the middle of the strut is unlocked followed by unlocking the quick release. The whole tube is moved up and spun 180° so that the slot on the opposite direction that used to face inwards now faces outwards. The bottom joint is now locked at the bottom end of the strut, followed by locking the quick release. This will result in the “Long Mode” of strut operation. This will allow the same strut to get another full length of telescoping to allow maximum distraction just with one strut.

FIG. 6A is a perspective view of strut attachment member 370 of the present invention that is configured to be coupled about the tube or body 260 of struts 200 a, 200 b. Strut attachment member 370 includes a ring connector portion 372, an intermediate portion 380 and a coupling portion 390. Strut attachment member 370 allows for two degrees of freedom between the strut and a respective ring that the strut is coupled to. The two degrees of freedom is obtained by utilizing one pivot joint and one hinge joint. FIG. 6B shows ring intermediate portion 380 and coupling portion 390 of strut attachment member 370 without ring connected portion 372. As shown in FIG. 6C, ring connector portion 372 includes a corner ledge portion 373 for receipt of a corresponding corner of rings 20, 30 to position ring connector portion 372 and to prevent rotation thereof prior to fixing ring connector portion 372 to rings 20, 30. A fastener (not shown) is received within aperture 374 and a hole of rings 20, 30 in order to secure ring connector portion 372 to rings 20, 30. Ring connector portion 372 includes first and second lateral bores 379 for receipt of pins (not shown) in order to secure post 382 of intermediate portion 380 within transverse aperture 375 of ring connector portion 372 defining a pivot joint.

As shown in FIG. 6B, post 382 includes a circular recess 383 therein, the pins being received in a portion of the recess after post 382 is fully received within transverse aperture 375 of ring connector portion 372 in order to secure post 382 of intermediate portion 380 within transverse aperture 375 while allowing intermediate portion 370 to pivot or rotate about a longitudinal axis L1 with respect to ring connector portion 372. Ring connector portion 372 further includes an inner surface 376 and an outer surface 377. The inner surface 376 is configured to lie adjacent a planar top or bottom surface of rings 20, 30 when ring connector portion 372 is coupled to rings 20, 30. Intermediate portion 380 further includes a u-shaped portion 384 extending from secure post 382. The u-shaped portion 384 includes first and second legs 385, 386 having apertures 388. A pivot pin 389 is received within apertures 388 of first and second legs as well as an aperture (not shown) in an extension 392 of coupling portion 390. Pivot pin 389 forms a hinge joint between intermediate portion 380 and coupling portion 390 and allows intermediate portion 380 to pivot with respect to coupling portion 390 about a longitudinal axis L2 perpendicular to L1. Coupling portion 390 further includes a bore 394 for receipt of tube 260 and a movable pin 396 received within an aperture 397 of coupling portion 390. Movable pin 396 is moved about an axis L3 in order to position coupling portion 390 within a corresponding feature 264 a, 264 b of tube 260 in order to position strut attachment 370 in either a first position as shown for example in FIG. 5A or a second configuration as shown for example in FIG. 5B.

FIG. 7 is a perspective view of strut attachment member 310 of the present invention that is configured to be coupled at an end of a strut. Strut attachment member 310 includes a ring connector portion 312 (similar to ring connector portion 372), an intermediate portion 320 (similar to ring connector portion 380) and a coupling portion 330. Coupling portion 300 includes a longitudinal bore 332 for receipt of a post 222 in order to couple coupling portion 300 to an end of the strut. Coupling portion 300 further includes a first aperture 316 and a second aperture 317, the first and second apertures 316, 317 being aligned substantially transverse and/or orthogonal to one another and to the longitudinal axis of struts 200 a, 200 b. First and second apertures 316, 317 may be used as attachment points for attaching additional components to strut 200 a, 200 b such as modular attachment piece 180.

Although the invention herein has been described with reference to particular embodiments, it is to be understood that these embodiments are merely illustrative of the principles and applications of the present invention. For example, features described in relation to one particular embodiment may be combined with features of other embodiments described herein. It is therefore to be understood that numerous modifications may be made to the illustrative embodiments and that other arrangements may be devised without departing from the spirit and scope of the present invention as defined by the appended claims. 

The invention claimed is:
 1. An external fixation system comprising: a first ring member; a second ring member; a first strut attachment member having a first portion having an aperture to receive a fastener to couple the first portion to the first ring member and a second portion coupled to a first end of an adjustable length strut, the second portion including an extension defining a longitudinal axis, and a third portion pivotably coupled to, and secured between, the first and second portions, the third portion having a pivot portion extending along the longitudinal axis from the third portion, the first portion secured to the pivot portion, the first portion being translationally fixed to the pivot portion along the longitudinal axis, the first portion being freely rotatable relative to the pivot portion about the longitudinal axis, the adjustable length strut being slidably received within the second portion transverse to the longitudinal axis; and a second strut attachment member having a first portion coupled to the second ring member and a second portion coupled to a length of the adjustable length strut, and a third portion pivotably coupled to the first and second portions.
 2. The external fixation system of claim 1, wherein the first strut attachment member includes a pin, the pin pivotably coupling the second and third portions of the first strut attachment member.
 3. The external fixation system of claim 1, wherein the first portion of the first strut attachment member has a bore adapted to receive a fastener for securing the first portion of the first strut attachment member to at least one of a plurality of holes in the first ring.
 4. The external fixation system of claim 1, wherein the first portion of the first strut attachment member is located proximally to a top surface of the first ring when the first strut attachment member is coupled to the first ring.
 5. The external fixation system of claim 1, wherein the adjustable length strut comprises: a rod member extending between the first end and a second end of the adjustable length strut, the rod member including external threads; a tube member extending between the first and second ends of the adjustable length strut, the tube member including a hollow portion adapted to receive the rod member and an engagement feature adapted to engage the external threads of the rod member; and an actuation mechanism rotatably fixed to the rod member, the actuation mechanism including a plurality of gear teeth extending radially outward of a longitudinal axis of the rod member.
 6. The external fixation system of claim 5, wherein the adjustable length strut further comprises a protrusion member coupled to an end portion of the rod member, the protrusion member extending substantially orthogonal to the longitudinal axis of the rod member, the protrusion member includes a collar portion substantially surrounding the end portion of the rod member, wherein the collar portion is freely rotatable with respect to the end portion of the rod member.
 7. The external fixation system of claim 6, wherein the tube member includes an elongate slot extending through inner and outer surfaces of the tube member, a portion of the protrusion member extends through a portion of the elongate slot, and wherein the tube member includes visual indicia on the outer surface thereof adjacent the slot.
 8. An external fixation system comprising: a first ring member; a second ring member; a first strut attachment member having a first portion having an aperture to receive a fastener to couple the first portion to the first ring member and a second portion coupled proximate to a first end of an adjustable length strut, the second portion including an extension defining a longitudinal axis, and a third portion pivotably coupled to the first and second portions, the third portion having a pivot portion extending along the longitudinal axis from the third portion, the first portion secured to the pivot portion, the first portion being translationally fixed to the pivot portion along the longitudinal axis, the first portion being freely rotatable relative to the pivot portion about the longitudinal axis, the adjustable length strut slidably received within a ring of the second portion transverse to the longitudinal axis; and a second strut attachment member having a first portion coupled to the second ring member and a second portion coupled to an outer surface of the adjustable length strut between the first end a second end of the adjustable length strut, and a third portion pivotably coupled to the first and second portions.
 9. The external fixation system of claim 8, wherein the first strut attachment member includes a pin, the pin pivotably coupling the second and third portions of the first strut attachment member.
 10. The external fixation system of claim 8, wherein the first portion of the first strut attachment member has a bore adapted to receive a fastener for securing the first portion of the first strut attachment member to at least one of a plurality of holes in the first ring.
 11. The external fixation system of claim 8, wherein the first portion of the first strut attachment member is located proximally to a top surface of the first ring when the first strut attachment member is coupled to the first ring.
 12. The external fixation system of claim 8, wherein the adjustable length strut comprises: a rod member extending between the first and second ends of the adjustable length strut, the rod member including external threads; a tube member extending between the first and second ends of the adjustable length strut, the tube member including a hollow portion adapted to receive the rod member and an engagement feature adapted to engage the external threads of the rod member; and an actuation mechanism rotatably fixed to the rod member, the actuation mechanism including a plurality of gear teeth extending radially outward of a longitudinal axis of the rod member.
 13. The external fixation system of claim 12, wherein the adjustable length strut further comprises a protrusion member coupled to an end portion of the rod member, the protrusion member extending substantially orthogonal to the longitudinal axis of the rod member, the protrusion member includes a collar portion substantially surrounding the end portion of the rod member, wherein the collar portion is freely rotatable with respect to the end portion of the rod member.
 14. The external fixation system of claim 13, wherein the tube member includes an elongate slot extending through inner and outer surfaces of the tube member, a portion of the protrusion member extends through a portion of the elongate slot, and wherein the tube member includes visual indicia on the outer surface thereof adjacent the slot.
 15. An external fixation system comprising: a first ring member; a second ring member; a first strut attachment member having a first portion having an aperture to receive a fastener to couple the first portion to the first ring member and a second portion coupled to a first end of an adjustable length strut, the second portion including an extension defining a longitudinal axis, and a third portion pivotably coupled to the first and second portions, the third portion having a pivot portion extending along the longitudinal axis from the third portion, the first portion secured to the pivot portion, the first portion being translationally fixed to the pivot portion along the longitudinal axis, the first portion being freely rotatable relative to the pivot portion about the longitudinal axis, the adjustable length strut slidably received within a ring of the second portion transverse to the longitudinal axis; and a second strut attachment member having a first portion coupled to the second ring member and a second portion coupled to one of a plurality of positions about the length of the adjustable length strut between the first end and a second end of the adjustable length strut, and a third portion pivotably coupled to the first and second portions.
 16. The external fixation system of claim 15, wherein the first strut attachment member includes a pin, the pin pivotably coupling the second and third portions of the first strut attachment member.
 17. The external fixation system of claim 15, wherein the first portion of the first strut attachment member has a bore adapted to receive a fastener for securing the first portion of the first strut attachment member to at least one of a plurality of holes in the first ring.
 18. The external fixation system of claim 15, wherein the first portion of the first strut attachment member is located proximally to a top surface of the first ring when the first strut attachment member is coupled to the first ring.
 19. The external fixation system of claim 15, wherein the adjustable length strut comprises: a rod member extending between the first and second ends of the adjustable length strut, the rod member including external threads; a tube member extending between the first and second ends of the adjustable length strut, the tube member including a hollow portion adapted to receive the rod member and an engagement feature adapted to engage the external threads of the rod member; and an actuation mechanism rotatably fixed to the rod member, the actuation mechanism including a plurality of gear teeth extending radially outward of a longitudinal axis of the rod member.
 20. The external fixation system of claim 19, wherein the adjustable length strut further comprises a protrusion member coupled to an end portion of the rod member, the protrusion member extending substantially orthogonal to the longitudinal axis of the rod member, the protrusion member includes a collar portion substantially surrounding the end portion of the rod member, wherein the collar portion is freely rotatable with respect to the end portion of the rod member.
 21. The external fixation system of claim 20, wherein the tube member includes an elongate slot extending through inner and outer surfaces of the tube member, a portion of the protrusion member extends through a portion of the elongate slot, and wherein the tube member includes visual indicia on the outer surface thereof adjacent the slot. 